Spinoff : What We Do, What We Used to Do

[NursingAgainstdaOdds]

The HIV thread reminded me of a thread I've wanted to start here for a while. (Apologies if it's been done!)

I love to hear accounts from experienced nurses about how nursing practice used to be, or how different practices have evolved. For example, an experienced traveller shared with me recently how patients with feeding tubes used to have what everyone else had - just pureed like crazy. (Interestingly to me, she also informed me that there was no such thing as a tube-fed patient with obligatory diarrhea. She felt this was because the patients got "real" food. I thought that was very thought-provoking.)

So, please share. Nursing history of all kinds really fascinates me. I wouldn't restrict this to practice-based issues, either - nurse/patient, nurse/doctor, nurse/nurse relationships have also evolved in fascinating ways. Let's hear it!

Edited to Add : I'm also interested if anyone has experiences which exemplify where certain procedural changes originated - i.e. our vigilance with IVs.

[Medic04]

In terms of cleaning incontinent pts, being able to wear gloves was a relief. Starting IVs.....I learned to start them without gloves, so I was never able to get the feel of starting them WITH gloves.

That is soooooooooo true.

[ASSEDO]

I remember:

A patient being put in the hospital for a week just for test. Sometimes a husband and wife team would enter the hospital, share the same room and rest & have test for a week.

Gving a patient enemas to clear, even if it was 12 enemas

Starting a lysis in each thigh with an IV butterfly needle to tritrate for dehydration.

A patient could afford to have several insurances (on one chart I counted 5 different insurances). The patient would enter the hospital for test, and each insurance was billed, one insurance would pay the hospital bill and the other 4 payments were sent to the patient, that way the patient made money from insurance.

Preparing a list of names for patients, so the local radio station would announce the names of hospital patient over the air.

Having moist heat pack that were not disposable.

Powdering rubber gloves.

When blood on your uniform, meant you worked hard that shift.

[Medic04]

Biggest

NO KIDS ALLOWED under 13! Nada zip none and let me tell you it WAS enforced.

Pt gett a full body massage( some eldery still expect it, and get mean when told we do not do them) Then complain service is not what it used to be.

pts smoking in the rooms

O2 was not piped through the hospital

YOU HAD to RENT the phone or TV in order to use it

RN standing at the Nurses station when a doctor arrived and sitting when told it was alright

Candystripers actually working, not just"hanging around" as they do now.

[suespets]

treating huge bedsores w/ tall floor lamps,and taping pt' butt over to the side rail(side rails now are almost non-existant) placeing m.o.m.on butt before heat lamping, for 20 mins.& don't be late in turning lamp off! this became obsolete w/ the advent of quartz lamps(used for around 1 minute,i think,& no m.o.m.) or packing bed sores w/sugar water soaked long cloth dressing strips, the bu"bugs would feed on the sugar,so tissue could heal.

[EmmaG, RN]

For those of you who were nurses at a time when gloves weren't required, how was it to make that transition to use gloves? Was the idea to start using gloves reject at first or was it a relief that it was required? Thanks in advance.

Very much a relief

I too was taught in school not to use gloves because it would make the patient feel "dirty". They instead taught us the fine art of wrapping a washcloth into a mitt. For suppositories, we used finger cots.

I remember the 3-11 charge telling me it hadn't been too long before I started nursing that morphine injection was mixed by the nurses. A tablet dissolved with sterile water or saline and then drawn up and injected.

When I started out, nurses mixed their own chemo. No hood, no PPE--- not even gloves. We mixed all our own meds. As an LPN, I had to take a hospital course to become an LPN II before I could hang TPN and mix my own IVFs. That brought my pay all the way up to $5.50 :)

Took care of patients with radiation implants. No badges. No shields. We did put them in the last room down the hall and would just peek at them from the doorway, so we at least had time and distance on our side lol.

Let's see.

Almost nothing was disposable. Metal everything. Cold bedpans...

Chest tubes systems were two big glass bottles that sat in a little wood and wire 'cage'.

No IV pumps, except on continuous chemo (we'd give adria continuously via a peripheral site).

Chemos were given on 3-11, so on nights we'd walk around with these big metal pans as patients vomited all shift. I never see anyone get sick like that nowadays. Sure, they have N/V at times, but nothing like they experienced back then.

We were a 36 bed unit, and ran with 2-3 nurses at night. Everything was handwritten, and every 5 days we'd have to write up another MAR for the patient.

Patients would come in for R&R, or because their families didn't want to deal with them. One of the saddest cases was an older woman (60ish, I think) with advanced cervical CA. Anyone who has cared for someone with that can tell you it has a very distinct, very bad odor.

Her daughter (the only family she had) asked the doc to admit her; she was going to have holiday parties and didn't want Mom around to 'stink up the house', and she wanted time to 'fumigate' before the festivities.

The gyn/onc was furious about how this woman was treated by her daughter, all but banished her to one room in the house. This was long before we were taught about reporting adult/elder abuse; I'm not even sure there was anything available that could have helped her back then. I remember the doc being incredibly frustrated with the whole issue.

Daughter berated her constantly, and this poor woman would scrub and bathe almost continuously to the point her skin was raw.

Every time we'd enter the room, she'd fall all over herself apologizing for the smell. She was with us from shortly after Thanksgiving through New Years, and no one in her family ever came to visit.

We did our best to make her comfortable, spend time with her and include her in our own parties and all, but of course it wasn't the same. That was her last Christmas, and she spent it in the hospital with strangers. To this day, I believe there's a special corner of hell reserved for that daughter.

Sorry to get off on that tangent. I often remember her this time of year, and especially when I think of my early years in nursing.

[Medic04]

When starting IVs , stuck the IV cath needle in the benchseat of the ambulance or in the cot, or in the gurney at the hospital till could find a needle box. ( Cause they were few and far between) Telling those around you "Watch that needle in the............":nono:

Instead of using a cell phone we used mics tuned to radios on the HEAR 340, you could hear all over the state if you had the right frequency( I know I heard my partner one night while visiting a hosp in IOWA LOL)

O2 was in steel tanks that felt like it weighed 50 lbs.

I know a few RNs showed me how to "sharpen needles"

Glass IV bottles

ceremanic bed pans "YOW! " :{

[EmmaG, RN]

Oh. Not long after I started working, the hospital got a hyperbaric chamber. Our surgeons went nuts over it. We'd prep the patients by giving them vit E and placing them in special all cotton gowns, removing all synthetics and metal. It was used for wound and decub patients, and one surgeon sent almost all his patients through it.

Had a young man with sickle cell who infarcted and was unconscious. They sent him to the hyperbaric and he came to while in the chamber. He freaked the hell out, thinking he was in a coffin and had been buried alive.

[EmmaG, RN]

pts smoking in the rooms

Even in semi's.

Nurses AND docs smoked at the station, break room, all over the unit. The air was literally blue with smoke at times.

This was a cancer unit :stone

[Medic04]

Oh. Not long after I started working, the hospital got a hyperbaric chamber. Our surgeons went nuts over it. We'd prep the patients by giving them vit E and placing them in special all cotton gowns, removing all synthetics and metal. It was used for wound and decub patients, and one surgeon sent almost all his patients through it.

Had a young man with sickle cell who infarcted and was unconscious. They sent him to the hyperbaric and he came to while in the chamber. He freaked the hell out, thinking he was in a coffin and had been buried alive.

OMG!

[suespets]

emmanuel: your blog re; the cervical ca mom brought tears to my eyes.so much for payback for giving your life up for your kids!

[Medic04]

Very much a relief

I too was taught in school not to use gloves because it would make the patient feel "dirty". They instead taught us the fine art of wrapping a washcloth into a mitt. For suppositories, we used finger cots.

I remember the 3-11 charge telling me it hadn't been too long before I started nursing that morphine injection was mixed by the nurses. A tablet dissolved with sterile water or saline and then drawn up and injected.

When I started out, nurses mixed their own chemo. No hood, no PPE--- not even gloves. We mixed all our own meds. As an LPN, I had to take a hospital course to become an LPN II before I could hang TPN and mix my own IVFs. That brought my pay all the way up to $5.50 :)

Took care of patients with radiation implants. No badges. No shields. We did put them in the last room down the hall and would just peek at them from the doorway, so we at least had time and distance on our side lol.

Let's see.

Almost nothing was disposable. Metal everything. Cold bedpans...

Chest tubes systems were two big glass bottles that sat in a little wood and wire 'cage'.

No IV pumps, except on continuous chemo (we'd give adria continuously via a peripheral site).

Chemos were given on 3-11, so on nights we'd walk around with these big metal pans as patients vomited all shift. I never see anyone get sick like that nowadays. Sure, they have N/V at times, but nothing like they experienced back then.

We were a 36 bed unit, and ran with 2-3 nurses at night. Everything was handwritten, and every 5 days we'd have to write up another MAR for the patient.

Patients would come in for R&R, or because their families didn't want to deal with them. One of the saddest cases was an older woman (60ish, I think) with advanced cervical CA. Anyone who has cared for someone with that can tell you it has a very distinct, very bad odor.

Her daughter (the only family she had) asked the doc to admit her; she was going to have holiday parties and didn't want Mom around to 'stink up the house', and she wanted time to 'fumigate' before the festivities.

The gyn/onc was furious about how this woman was treated by her daughter, all but banished her to one room in the house. This was long before we were taught about reporting adult/elder abuse; I'm not even sure there was anything available that could have helped her back then. I remember the doc being incredibly frustrated with the whole issue.

Daughter berated her constantly, and this poor woman would scrub and bathe almost continuously to the point her skin was raw.

Every time we'd enter the room, she'd fall all over herself apologizing for the smell. She was with us from shortly after Thanksgiving through New Years, and no one in her family ever came to visit.

We did our best to make her comfortable, spend time with her and include her in our own parties and all, but of course it wasn't the same. That was her last Christmas, and she spent it in the hospital with strangers. To this day, I believe there's a special corner of hell reserved for that daughter.

Sorry to get off on that tangent. I often remember her this time of year, and especially when I think of my early years in nursing.

HUG

That is so so sad. Hell is not good enough IMHO

[canoehead, BSN, RN]

I remember runners whose only job was to go throughout the hospital gathering and delivering various slips and papers. Everything was done by paper- no computers, so they'd make a stop every 20-30 minutes or so, and someone would have to weed through all the papers and mount them on the chart. Some runners used rollerskates to make better time.

Mercury thermometers that required 5 minutes under the tongue for the correct reading, then were disinfected on the floor and reused. Rectal mercury thermometers and toddlers- OMG.